COVID-19 and the use of immunomodulatory and biologic agents for severe cutaneous disease: An Australian/New Zealand consensus statement

Australas J Dermatol. 2020 Aug;61(3):210-216. doi: 10.1111/ajd.13313. Epub 2020 May 3.


Patients on immunomodulators, including biologic agents and new small molecular inhibitors, for cutaneous disease, represent a potentially vulnerable population during the COVID-19 pandemic. There is currently insufficient evidence to determine whether patients on systemic immunomodulators are at increased risk of developing COVID-19 disease or more likely to have severe disease. As such, clinicians need to assess the benefit-to-risk ratio on a case-by-case basis. In patients with suspected or confirmed COVID-19 disease, all immunomodulators used for skin diseases should be immediately withheld, with the possible exception of systemic corticosteroid therapy, which needs to be weaned. In patients who develop symptoms or signs of an upper respiratory tract infection, but COVID-19 is not yet confirmed, consider dose reduction or temporarily cessation for 1-2 weeks. In otherwise well patients, immunomodulators and biologics should be continued. In all patients, and their immediate close contacts, the importance of preventative measures to minimise human-to-human transmission cannot be overemphasised.

Keywords: COVID-19; Janus Kinase Inhibitors; biologic agents; biologics; ciclosporin; dermatolology; immunomodulators; methotrexate; systemic steroids.

Publication types

  • Review

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Australia
  • Betacoronavirus*
  • Biological Factors / therapeutic use*
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • New Zealand
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / therapy*
  • SARS-CoV-2
  • Skin Diseases / complications
  • Skin Diseases / drug therapy*


  • Anti-Infective Agents
  • Biological Factors
  • Immunosuppressive Agents